Anaspure Omkar S, Patel Shiv, Baumann Anthony N, Lenz Theodor, Pascual-Leone Nicolas, Anastasio Albert T, Lau Brian C
Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19140, USA.
College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
Eur J Orthop Surg Traumatol. 2024 Dec 12;35(1):35. doi: 10.1007/s00590-024-04145-9.
This study evaluates the impact of smoking on clinical outcomes following hip arthroscopy (HA) through a systematic review and meta-analysis.
This systematic review and meta-analysis queried PubMed, Scopus, Cochrane, and CINAHL from inception to April 30, 2024, for articles related to smoking and HA outcomes. A random-effects model meta-analysis using relative risk (RR) and 95% confidence intervals was performed to compare smokers and nonsmokers for conversion to total hip arthroplasty (THA) and revision hip arthroscopy (RHA).
Twenty observational studies (n = 115,203 patients; 66.95% female; mean age: 36.93 ± 6.53 years; mean follow-up: 22.10 ± 7.56 months) were included. Nine studies investigated smoking and conversion to THA, six examined smoking and RHA, eight assessed smoking and postoperative patient-reported outcomes, and eight evaluated smoking and postoperative complications. Regarding conversion to THA, 5 studies (55.56%) found a significant association, while 4 (44.44%) did not. Meta-analysis from four studies found no significant association between smoking and THA conversion (p = 0.48, OR: 1.02; 95% CI: [0.98-1.06]) or smoking and RHA (p = 0.305, OR: 1.00; 95% CI: [0.97-1.03]). Only 2 studies (33.33%) found a significant association between smoking and RHA, whereas four did not. Six studies found smoking significantly implicated in complications such as HA failure, increased opioid use, infection risk, and venous thromboembolism (VTE). THA conversion rates were 6.54% (n = 14/214) among smokers versus 3.57% (n = 13/364) among nonsmokers.
This study found no statistically significant association between smoking and THA conversion, though smokers were observed to experience higher conversion rates overall. Similarly, no significant association was observed for smoking and RHA at 2-year follow-up. However, trends suggest that smokers experience greater risks of adverse outcomes, particularly VTE and HA failure, which should be considered in clinical decision-making.
Level III.
本研究通过系统评价和荟萃分析评估吸烟对髋关节镜检查（HA）后临床结局的影响。
本系统评价和荟萃分析检索了从创刊至2024年4月30日的PubMed、Scopus、Cochrane和CINAHL数据库，以查找与吸烟和HA结局相关的文章。采用随机效应模型荟萃分析，使用相对风险（RR）和95%置信区间，比较吸烟者和非吸烟者转为全髋关节置换术（THA）和翻修髋关节镜检查（RHA）的情况。
纳入了20项观察性研究（n = 115203例患者；66.95%为女性；平均年龄：36.93±6.53岁；平均随访时间：22.10±7.56个月）。9项研究调查了吸烟与转为THA的关系，6项研究检查了吸烟与RHA的关系，8项研究评估了吸烟与术后患者报告结局的关系，8项研究评估了吸烟与术后并发症的关系。关于转为THA，5项研究（55.56%）发现有显著关联，而4项研究（44.44%）未发现。四项研究的荟萃分析发现吸烟与THA转换（p = 0.48，OR：1.02；95%CI：[0.98 - 1.06]）或吸烟与RHA（p = 0.305，OR：1.00；95%CI：[0.97 - 1.03]）之间无显著关联。只有2项研究（33.33%）发现吸烟与RHA之间有显著关联，而4项研究未发现。6项研究发现吸烟与HA失败、阿片类药物使用增加、感染风险和静脉血栓栓塞（VTE）等并发症有显著关联。吸烟者的THA转换率为6.54%（n = 14/214），而非吸烟者为3.57%（n = 13/364）。
本研究发现吸烟与THA转换之间无统计学显著关联，尽管观察到吸烟者总体转换率较高。同样，在2年随访中，吸烟与RHA之间也未观察到显著关联。然而，趋势表明吸烟者出现不良结局的风险更大，尤其是VTE和HA失败，在临床决策中应予以考虑。
三级。
